Effectiveness of a family-centered method for the early identification of social-emotional and behavioral problems in children: a quasi experimental study

Background: Social-emotional and behavioral problems are common in childhood. Early identification of these is important as it can lead to interventions which may improve the child's prognosis. In Dutch Preventive Child Healthcare (PCH), a new family-centered method has been implemented to identify these problems in early childhood. Its main features are consideration of the child's developmental context and empowerment of parents to enhance the developmental context. Methods/design: In a quasi-experimental study, embedded in routine PCH in the Netherlands, regions in which the family-centered method has been implemented (intervention condition) will be compared to "care as usual" regions (control condition). These regions are comparable in regard to socio-demographic characteristics. From more than 3,500 newborn babies, 18-month follow-up data on social-emotional and behavioral development will be obtained. PCH professionals will assess development during each routine well-child visit; participating parents will fill in standardized questionnaires. Primary outcomes in the study are the proportion of social-emotional and behavioral problems identified by PCH professionals in children aged 2-14 and 18 months in both conditions, and the proportion of agreement between the assessment of PCH professionals and parents. In addition, the added value of the family-centered approach will be assessed by comparing PCH findings with standardized questionnaires. The secondary outcomes are the degree to which the needs of parents are met and the degree to which they are willing to disclose concerns. Discussion: The family-centered method seems promising for early identification of social-emotional and behavioral problems. The results of this study will contribute to evidence-based public health. Trial registration: NTR2681

Scoping review of patient- and family-oriented outcomes and measures for chronic pediatric disease.

Improvements in health care for children with chronic diseases must be informed by research that emphasizes outcomes of importance to patients and families. To support a program of research in the field of rare inborn errors of metabolism (IEM), we conducted a broad scoping review of primary studies that: (i) focused on chronic pediatric diseases similar to IEM in etiology or manifestations and in complexity of management; (ii) reported patient- and/or family-oriented outcomes; and (iii) measured these outcomes using self-administered tools.We developed a comprehensive review protocol and implemented an electronic search strategy to identify relevant citations in Medline, EMBASE, DARE and Cochrane. Two reviewers applied pre-specified criteria to titles/abstracts using a liberal accelerated approach. Articles eligible for full-text review were screened by two independent reviewers with discrepancies resolved by consensus. One researcher abstracted data on study characteristics, patient- and family-oriented outcomes, and self-administered measures. Data were validated by a second researcher.4,118 citations were screened with 304 articles included. Across all included reports, the most-represented diseases were diabetes (35%), cerebral palsy (23%) and epilepsy (18%). We identified 43 unique patient- and family-oriented outcomes from among five emergent domains, with mental health outcomes appearing most frequently. The studies reported the use of 405 independent self-administered measures of these outcomes.Patient- and family-oriented research investigating chronic pediatric diseases emphasizes mental health and appears to be relatively well-developed in the diabetes literature. Future research can build on this foundation while identifying additional outcomes that are priorities for patients and families

Reform in Australian medical schools: a collaborative approach to realising Indigenous health potential

• The Australian medical education system is at a critical juncture in relation to what and how it delivers for Aboriginal and Torres Strait Islander health. • Since 2004, three key organisations concerned with medical education have worked to provide a toolkit for implementation of sustainable reform within medical schools. • The aim is a medical workforce trained in Indigenous health, and more Aboriginal and Torres-Strait Islander doctors, leading to better health for Australia's Indigenous peoples

Interaction experience for families who lives with their child's disease and hospitalization La experiencia de interacción de la familia que vive la enfermedad y hospitalización del niño A experiência de interação da família que vivencia a doença e hospitalização da criança

Starting from the research question about the meanings the family attributes to interactions experienced during their child's hospitalization, this study tried to understand the interaction experience of families in pediatric hospitals, as well to identify the interventions considered effective the family's perspective. Symbolic Interactionism was the theoretical framework that supported the data analysis process, and Grounded Theory was the methodological framework. Six families with hospitalized children participated. The results allowed us to identify the phenomena "feeling secure to assume risks" and "feeling insecure to assume risks", representing the symbolic meanings attributed to relational contexts that emerge from interaction between families and health professionals. The identified concepts significantly contribute to achieve a better understanding of the family-centered care approach and provide a way to reflect on interaction and intervention with families in pediatric clinical care practice.<br>A partir del cuestionamiento sobre cuales son los significados atribuidos por la familia a las interacciones vivenciadas a lo largo de la hospitalización del niño, este estudio buscó comprender la experiencia interaccional de la familia en el hospital pediátrico así como identificar las intervenciones consideradas efectivas en la perspectiva de la familia. El estudio tuvo como orientación teórica el Interacionismo Simbólico, que dio sustentación al proceso del análisis de los datos, y tuvo como referencial metodológico la Teoría Fundamentada en los Datos. Participaron del estudio 6 familias de niños hospitalizados. Los resultados permitieron identificar dos fenómenos: "sintiéndose segura para asumir riesgos" y "sintiéndose insegura para asumir riesgos", representativos de los significados simbólicos atribuidos a contextos relacionales que emergen de la interacción de la familia con los profesionales de salud. Los conceptos identificados contribuyen en especial para ampliar la comprensión de la aproximación de cuidado centrada en la familia, además de proporcionar un camino a la reflexión con respecto a la interacción e intervención con la familia en la práctica pediátrica.<br>A partir do questionamento sobre quais os significados atribuídos pela família às interações vivenciadas durante a hospitalização da criança, este estudo buscou compreender a experiência interacional da família no hospital pediátrico e identificar as intervenções consideradas efetivas sob a perspectiva da família. O estudo teve como orientação teórica o Interacionismo Simbólico, que conferiu sustentação ao processo de análise dos dados e como referencial metodológico a Teoria Fundamentada nos Dados. Participaram do estudo 6 famílias de crianças hospitalizadas. Os resultados permitiram a identificação dos fenômenos "sentindo-se segura para assumir riscos" e "sentindo-se insegura para assumir riscos", representativos dos significados simbólicos atribuídos aos contextos relacionais que emergem da interação entre a família e os profissionais de saúde. Os conceitos identificados contribuem especialmente para ampliar a compreensão da abordagem de cuidado centrado na família e proporcionam um caminho para a reflexão acerca da interação e intervenção com a família na prática clínica pediátrica